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Erschienen in: Clinical Orthopaedics and Related Research® 9/2013

01.09.2013 | Symposium: Tscherne Festschrift

Trauma Care in Germany: An Inclusive System

verfasst von: Johannes A. Sturm, MD, Hans-Christoph Pape, MD, Thomas Dienstknecht, MD

Erschienen in: Clinical Orthopaedics and Related Research® | Ausgabe 9/2013

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Abstract

Background

Development of trauma systems is a demanding process. The United States and Germany both have sophisticated trauma systems. This manuscript is a summary of political, economic, and medical changes that have led to the development of both trauma systems and the current high-quality standards.

Questions/purposes

We specifically asked three questions: (1) What tasks are involved in developing a modern trauma system? (2) What is the approach to achieve this task? (3) Do these systems work?

Methods

We conducted a systematic review of relevant articles by searching electronic databases (PubMed, Embase, Cochrane library) using the following search terms: “trauma system”, “polytrauma”, “trauma networks”, and “trauma registry”. Of 2573 retrieved manuscripts, the authors made a personal selection of studies. A personal study selection from our experiences was added when their contribution to the topic was judged important.

Results

Worldwide, similar tasks concerning trauma care have to be addressed. In most societies, traffic accidents and firearm-related injuries contribute to a high number of trauma victims. The German approach has been to decrease the number of accidents through injury prevention and to provide better care by establishing an emergency medical system. For in-hospital treatment, clinical care has constantly improved and a close interaction with members from the American Association for the Surgery of Trauma and the Orthopaedic Trauma Association has helped a great deal to achieve these improvements. The German healthcare system was developed as a powerful healthcare tool covering patients from injury to rehabilitation. In addition, trauma and injury research has been strengthened to deal with various questions of trauma care.

Conclusions

Organized injury prevention programs and systematized professional patient care can address the issues associated with the global burden of trauma. These trauma systems require constant monitoring and improvement.
Literatur
1.
Zurück zum Zitat American College of Surgeons. Resources for optimal care of the injured patient: an update. Task Force of the Committee on Trauma, American College of Surgeons. Bull Am Coll Surg. 1990;75:20–29. American College of Surgeons. Resources for optimal care of the injured patient: an update. Task Force of the Committee on Trauma, American College of Surgeons. Bull Am Coll Surg. 1990;75:20–29.
2.
Zurück zum Zitat Bardenheuer M, Obertacke U, Schmit-Neuerburg KP; AG Polytrauma der DGU. [The German Trauma Registry: a tool to describe trauma care in Germany] [in German]. Hefte zu Der Unfallchirurg. 1997;268:269–273.CrossRef Bardenheuer M, Obertacke U, Schmit-Neuerburg KP; AG Polytrauma der DGU. [The German Trauma Registry: a tool to describe trauma care in Germany] [in German]. Hefte zu Der Unfallchirurg. 1997;268:269–273.CrossRef
3.
Zurück zum Zitat Barkhausen T, Hildebrand F, Krettek C, van Griensven M. DHEA-dependent and organ-specific regulation of TNF-alpha mRNA expression in a murine polymicrobial sepsis and trauma model. Crit Care. 2009;13:R114.PubMedCrossRef Barkhausen T, Hildebrand F, Krettek C, van Griensven M. DHEA-dependent and organ-specific regulation of TNF-alpha mRNA expression in a murine polymicrobial sepsis and trauma model. Crit Care. 2009;13:R114.PubMedCrossRef
4.
Zurück zum Zitat Baxt WG, Moody P. The impact of a physician as part of the aeromedical prehospital team in patients with blunt trauma. JAMA. 1987;257:3246–3250.PubMedCrossRef Baxt WG, Moody P. The impact of a physician as part of the aeromedical prehospital team in patients with blunt trauma. JAMA. 1987;257:3246–3250.PubMedCrossRef
5.
Zurück zum Zitat Bedford D, McKeown N, O’Farrell A, Howell F. Alcohol levels in killed drivers and pedestrians on Irish roads 2003–2005: a national study. Ir Med J. 2009;102:310, 312–314. Bedford D, McKeown N, O’Farrell A, Howell F. Alcohol levels in killed drivers and pedestrians on Irish roads 2003–2005: a national study. Ir Med J. 2009;102:310, 312–314.
6.
Zurück zum Zitat Böhler L. Die Technik der Knochenbruchbehandlung. Vienna, Austria: Verlag für Medizinische Wissenschaften; 1929. Böhler L. Die Technik der Knochenbruchbehandlung. Vienna, Austria: Verlag für Medizinische Wissenschaften; 1929.
7.
Zurück zum Zitat Bohn A, Lukas R. [Prehospital treatment of polytrauma patients by emergency physicians] [in German]. Anasthesiol Intensivmed Notfallmed Schmerzther. 2012;47:708–714.PubMedCrossRef Bohn A, Lukas R. [Prehospital treatment of polytrauma patients by emergency physicians] [in German]. Anasthesiol Intensivmed Notfallmed Schmerzther. 2012;47:708–714.PubMedCrossRef
8.
Zurück zum Zitat Border JR. Death from severe trauma: open fractures to multiple organ dysfunction syndrome. J Trauma. 1995;39:12–22.PubMedCrossRef Border JR. Death from severe trauma: open fractures to multiple organ dysfunction syndrome. J Trauma. 1995;39:12–22.PubMedCrossRef
9.
Zurück zum Zitat Cales RH. Trauma mortality in Orange County: the effect of implementation of a regional trauma system. Ann Emerg Med. 1984;13:1–10PubMedCrossRef Cales RH. Trauma mortality in Orange County: the effect of implementation of a regional trauma system. Ann Emerg Med. 1984;13:1–10PubMedCrossRef
10.
Zurück zum Zitat Carr BG, Caplan JM, Pryor JP, Branas CC. A meta-analysis of prehospital care times for trauma. Prehosp Emerg Care. 2006;10:198–206.PubMedCrossRef Carr BG, Caplan JM, Pryor JP, Branas CC. A meta-analysis of prehospital care times for trauma. Prehosp Emerg Care. 2006;10:198–206.PubMedCrossRef
12.
Zurück zum Zitat Civetta J, Hudson-Civetta J. Maintaining quality of care while reducing charges in the ICU. Ann Surg. 1985;202:524–531.PubMedCrossRef Civetta J, Hudson-Civetta J. Maintaining quality of care while reducing charges in the ICU. Ann Surg. 1985;202:524–531.PubMedCrossRef
16.
Zurück zum Zitat Dwenger A, Pape HC, Bantel C, Schweitzer G, Krumm K, Grotz M, Lueken B, Funck M, Regel G. Ascorbic acid reduces the endotoxin-induced lung injury in awake sheep. Eur J Clin Invest. 1994;24:229–235.PubMedCrossRef Dwenger A, Pape HC, Bantel C, Schweitzer G, Krumm K, Grotz M, Lueken B, Funck M, Regel G. Ascorbic acid reduces the endotoxin-induced lung injury in awake sheep. Eur J Clin Invest. 1994;24:229–235.PubMedCrossRef
17.
Zurück zum Zitat Dwenger A, Regel G, Ellendorff B, Schweitzer G, Funck M, Limbrock H, Sturm JA, Tscherne H. Alveolar cell pattern and chemiluminescence response of blood neutrophils and alveolar macrophages in sheep after endotoxin injection. J Clin Chem Clin Biochem. 1990;28:163–168.PubMed Dwenger A, Regel G, Ellendorff B, Schweitzer G, Funck M, Limbrock H, Sturm JA, Tscherne H. Alveolar cell pattern and chemiluminescence response of blood neutrophils and alveolar macrophages in sheep after endotoxin injection. J Clin Chem Clin Biochem. 1990;28:163–168.PubMed
18.
Zurück zum Zitat Edwards A, Di Bartolomeo S, Chieregato A, Coats T, Della Corte F, Giannoudis P, Gomes E, Groenborg H, Lefering R, Leppaniemi A, Lossius HM, Ortenwal P, Roise O, Rusnak M, Sturms L, Smith M, Bondegaard Thomsen A, Willett K, Woodford M, Yates D, Lecky F. A comparison of European Trauma Registries: the first report from the EuroTARN Group. Resuscitation. 2007;75:286–297.PubMedCrossRef Edwards A, Di Bartolomeo S, Chieregato A, Coats T, Della Corte F, Giannoudis P, Gomes E, Groenborg H, Lefering R, Leppaniemi A, Lossius HM, Ortenwal P, Roise O, Rusnak M, Sturms L, Smith M, Bondegaard Thomsen A, Willett K, Woodford M, Yates D, Lecky F. A comparison of European Trauma Registries: the first report from the EuroTARN Group. Resuscitation. 2007;75:286–297.PubMedCrossRef
19.
Zurück zum Zitat Garner A, Rashford S, Lee A, Bartolacci R. Addition of physicians to paramedic helicopter services decreases blunt trauma mortality. Aust N Z J Surg. 1999;69:697–701.PubMedCrossRef Garner A, Rashford S, Lee A, Bartolacci R. Addition of physicians to paramedic helicopter services decreases blunt trauma mortality. Aust N Z J Surg. 1999;69:697–701.PubMedCrossRef
20.
Zurück zum Zitat Garnowski M, Manner H. On factors related to car accidents on German Autobahn connectors. Accid Anal Prev. 2011;43:1864–1871.PubMedCrossRef Garnowski M, Manner H. On factors related to car accidents on German Autobahn connectors. Accid Anal Prev. 2011;43:1864–1871.PubMedCrossRef
22.
Zurück zum Zitat Goris RJ, teBoekhorst TP, Nuytinck JK, Gimbrere JS. Multiple-organ failure: generalized autodestructive inflammation? Arch Surg. 1985;120:1109–1115.PubMedCrossRef Goris RJ, teBoekhorst TP, Nuytinck JK, Gimbrere JS. Multiple-organ failure: generalized autodestructive inflammation? Arch Surg. 1985;120:1109–1115.PubMedCrossRef
23.
Zurück zum Zitat Grotz M, Hohensee A, Remmers D, Wagner TO, Regel G. Rehabilitation results of patients with multiple injuries and multiple organ failure and long-term intensive care. J Trauma. 1997;42:919–926.PubMedCrossRef Grotz M, Hohensee A, Remmers D, Wagner TO, Regel G. Rehabilitation results of patients with multiple injuries and multiple organ failure and long-term intensive care. J Trauma. 1997;42:919–926.PubMedCrossRef
24.
Zurück zum Zitat Grotz MR, Deitch EA, Ding J, Xu D, Huang Q, Regel G. Intestinal cytokine response after gut ischemia: role of gut barrier failure. Ann Surg. 1999;229:478–486.PubMedCrossRef Grotz MR, Deitch EA, Ding J, Xu D, Huang Q, Regel G. Intestinal cytokine response after gut ischemia: role of gut barrier failure. Ann Surg. 1999;229:478–486.PubMedCrossRef
25.
Zurück zum Zitat Grotz MR, Ding J, Guo W, Huang Q, Deitch EA. Comparison of plasma cytokine levels in rats subjected to superior mesenteric artery occlusion or hemorrhagic shock. Shock. 1995;3:362–368.PubMed Grotz MR, Ding J, Guo W, Huang Q, Deitch EA. Comparison of plasma cytokine levels in rats subjected to superior mesenteric artery occlusion or hemorrhagic shock. Shock. 1995;3:362–368.PubMed
26.
Zurück zum Zitat Gunning M, O’Loughlin E, Fletcher M, Crilly J, Hooper M, Ellis DY. Emergency intubation: a prospective multicentre descriptive audit in an Australian helicopter emergency medical service. Emerg Med J. 2009;26:65–69.PubMedCrossRef Gunning M, O’Loughlin E, Fletcher M, Crilly J, Hooper M, Ellis DY. Emergency intubation: a prospective multicentre descriptive audit in an Australian helicopter emergency medical service. Emerg Med J. 2009;26:65–69.PubMedCrossRef
27.
Zurück zum Zitat Hardcastle TC, Finlayson M, van Heerden M, Johnson B, Samuel C, Muckart DJ. The Prehospital Burden of Disease due to Trauma in KwaZulu-Natal: The Need for Afrocentric Trauma Systems. World J Surg. 2012 November 30 [Epub ahead of print]. Hardcastle TC, Finlayson M, van Heerden M, Johnson B, Samuel C, Muckart DJ. The Prehospital Burden of Disease due to Trauma in KwaZulu-Natal: The Need for Afrocentric Trauma Systems. World J Surg. 2012 November 30 [Epub ahead of print].
28.
Zurück zum Zitat Holubowycz OT, Kloeden CN, McLean AJ. Age, sex, and blood alcohol concentration of killed and injured drivers, riders, and passengers. Accid Anal Prev. 1994;26:483–492.PubMedCrossRef Holubowycz OT, Kloeden CN, McLean AJ. Age, sex, and blood alcohol concentration of killed and injured drivers, riders, and passengers. Accid Anal Prev. 1994;26:483–492.PubMedCrossRef
29.
Zurück zum Zitat Iirola TT, Laaksonen MI, Vahlberg TJ, Pälve HK. Effect of physician-staffed helicopter emergency medical service on blunt trauma patient survival and prehospital care. Eur J Emerg Med. 2006;13:335–339.PubMedCrossRef Iirola TT, Laaksonen MI, Vahlberg TJ, Pälve HK. Effect of physician-staffed helicopter emergency medical service on blunt trauma patient survival and prehospital care. Eur J Emerg Med. 2006;13:335–339.PubMedCrossRef
30.
Zurück zum Zitat Karch DL, Logan J, McDaniel D, Parks S, Patel N; Centers for Disease Control and Prevention (CDC). Surveillance for violent deaths—National Violent Death Reporting System, 16 states, 2009. MMWR Surveill Summ. 2012;61:1–43.PubMed Karch DL, Logan J, McDaniel D, Parks S, Patel N; Centers for Disease Control and Prevention (CDC). Surveillance for violent deaths—National Violent Death Reporting System, 16 states, 2009. MMWR Surveill Summ. 2012;61:1–43.PubMed
31.
Zurück zum Zitat Kejriwal R, Civil I. Time to definitive care for patients with moderate and severe traumatic brain injury—does a trauma system matter? N Z Med J. 2009;122:40–46.PubMed Kejriwal R, Civil I. Time to definitive care for patients with moderate and severe traumatic brain injury—does a trauma system matter? N Z Med J. 2009;122:40–46.PubMed
32.
Zurück zum Zitat Kinzl L, Gebhard F, Arand M. [Polytrauma and economics] [in German]. Unfallchirurg. 1996;22:179–185. Kinzl L, Gebhard F, Arand M. [Polytrauma and economics] [in German]. Unfallchirurg. 1996;22:179–185.
33.
Zurück zum Zitat Kirschner M. [The mobile surgical hospital] [in German]. Chirurg. 1938;10:713–715. Kirschner M. [The mobile surgical hospital] [in German]. Chirurg. 1938;10:713–715.
34.
Zurück zum Zitat Ladou J. The European influence on workers’ compensation reform in the United States. Environ Health. 2011;10:103.PubMedCrossRef Ladou J. The European influence on workers’ compensation reform in the United States. Environ Health. 2011;10:103.PubMedCrossRef
35.
Zurück zum Zitat Lee Y, Lee M. Implementation of safety driving system using e-health and telematics technology. Telemed J E Health. 2008;14:598–605.PubMedCrossRef Lee Y, Lee M. Implementation of safety driving system using e-health and telematics technology. Telemed J E Health. 2008;14:598–605.PubMedCrossRef
36.
Zurück zum Zitat MacKenzie EJ, Siegel JH, Shapiro S, Moody M, Smith RT. Functional recovery and medical costs of trauma: an analysis by type and severity of injury. J Trauma. 1988;28:281–297.PubMedCrossRef MacKenzie EJ, Siegel JH, Shapiro S, Moody M, Smith RT. Functional recovery and medical costs of trauma: an analysis by type and severity of injury. J Trauma. 1988;28:281–297.PubMedCrossRef
37.
Zurück zum Zitat Mir MU, Razzak JA, Ahmad K. Commercial vehicles and road safety in Pakistan: exploring high-risk attributes among drivers and vehicles. Int J Inj Contr Saf Promot. 2012 October 24 [Epub ahead of print]. Mir MU, Razzak JA, Ahmad K. Commercial vehicles and road safety in Pakistan: exploring high-risk attributes among drivers and vehicles. Int J Inj Contr Saf Promot. 2012 October 24 [Epub ahead of print].
38.
Zurück zum Zitat Muhrer E, Reinprecht K, Vollrath M. Driving with a partially autonomous forward collision warning system: how do drivers react? Hum Factors. 2012;54:698–708.PubMedCrossRef Muhrer E, Reinprecht K, Vollrath M. Driving with a partially autonomous forward collision warning system: how do drivers react? Hum Factors. 2012;54:698–708.PubMedCrossRef
39.
Zurück zum Zitat Neugebauer EA, Waydhas C, Lendemans S, Rixen D, Eikermann M, Pohlemann T. The treatment of patients with severe and multiple traumatic injuries. Dtsch Arztebl Int. 2012;109:102–108.PubMed Neugebauer EA, Waydhas C, Lendemans S, Rixen D, Eikermann M, Pohlemann T. The treatment of patients with severe and multiple traumatic injuries. Dtsch Arztebl Int. 2012;109:102–108.PubMed
40.
Zurück zum Zitat Oberbeck R, Dahlweid M, Koch R, van Griensven M, Emmendörfer A, Tscherne H, Pape HC. Dehydroepiandrosterone decreases mortality rate and improves cellular immune function during polymicrobial sepsis. Crit Care Med. 2001;29:380–384.PubMedCrossRef Oberbeck R, Dahlweid M, Koch R, van Griensven M, Emmendörfer A, Tscherne H, Pape HC. Dehydroepiandrosterone decreases mortality rate and improves cellular immune function during polymicrobial sepsis. Crit Care Med. 2001;29:380–384.PubMedCrossRef
41.
Zurück zum Zitat Obertacke U, Neudeck F, Wihs HJ, Schmit-Neuerburg KP. [Cost analysis of primary care and intensive care treatment of multiple trauma patients] [in German]. Unfallchirurg. 1997;100:44–49.PubMedCrossRef Obertacke U, Neudeck F, Wihs HJ, Schmit-Neuerburg KP. [Cost analysis of primary care and intensive care treatment of multiple trauma patients] [in German]. Unfallchirurg. 1997;100:44–49.PubMedCrossRef
42.
Zurück zum Zitat Oestern HJ. [Management of polytrauma patients in an international comparison] [in German]. Unfallchirurg. 1999;102:80–91.PubMedCrossRef Oestern HJ. [Management of polytrauma patients in an international comparison] [in German]. Unfallchirurg. 1999;102:80–91.PubMedCrossRef
43.
Zurück zum Zitat Pape H, Stalp M, Dahlweid M, Regel G, Tscherne H. [Optimal duration of primary surgery with regards to a “borderline”-situation in polytrauma patients. Arbeitsgemeinschaft “Polytrauma” der Deutschen Gesellschaft für Unfallchirurgie] [in German]. Unfallchirurg. 1999;102:861–869.PubMedCrossRef Pape H, Stalp M, Dahlweid M, Regel G, Tscherne H. [Optimal duration of primary surgery with regards to a “borderline”-situation in polytrauma patients. Arbeitsgemeinschaft “Polytrauma” der Deutschen Gesellschaft für Unfallchirurgie] [in German]. Unfallchirurg. 1999;102:861–869.PubMedCrossRef
44.
Zurück zum Zitat Pape HC, Auf’m’Kolk M, Paffrath T, Regel G, Sturm JA, Tscherne H. Primary intramedullary femur fixation in multiple trauma patients with associated lung contusion: a cause of post-traumatic ARDS? J Trauma. 1993;540–548; discussion 547–548. Pape HC, Auf’m’Kolk M, Paffrath T, Regel G, Sturm JA, Tscherne H. Primary intramedullary femur fixation in multiple trauma patients with associated lung contusion: a cause of post-traumatic ARDS? J Trauma. 1993;540–548; discussion 547–548.
45.
Zurück zum Zitat Pape HC, Bartels M, Pohlemann T, Werner T, von Glinski S, Baur H, Tscherne H. Coagulatory response after femoral instrumentation after severe trauma in sheep. J Trauma. 1998;45:720–728.PubMedCrossRef Pape HC, Bartels M, Pohlemann T, Werner T, von Glinski S, Baur H, Tscherne H. Coagulatory response after femoral instrumentation after severe trauma in sheep. J Trauma. 1998;45:720–728.PubMedCrossRef
46.
Zurück zum Zitat Pape HC, Dwenger A, Grotz M, Kaever V, Negatsch R, Kleemann W, Regel G, Sturm JA, Tscherne H. Does the reamer type influence the degree of lung dysfunction after femoral nailing following severe trauma? An animal study. J Orthop Trauma. 1994;300–309. Pape HC, Dwenger A, Grotz M, Kaever V, Negatsch R, Kleemann W, Regel G, Sturm JA, Tscherne H. Does the reamer type influence the degree of lung dysfunction after femoral nailing following severe trauma? An animal study. J Orthop Trauma. 1994;300–309.
47.
Zurück zum Zitat Pape HC, Dwenger A, Regel G, Auf’m’Kolck M, Gollub F, Wisner D, Sturm JA, Tscherne H. Increased gut permeability after multiple trauma. Br J Surg. 1994;81:850–852.PubMedCrossRef Pape HC, Dwenger A, Regel G, Auf’m’Kolck M, Gollub F, Wisner D, Sturm JA, Tscherne H. Increased gut permeability after multiple trauma. Br J Surg. 1994;81:850–852.PubMedCrossRef
48.
Zurück zum Zitat Pape HC, Dwenger A, Regel G, Schweitzer G, Jonas M, Remmers D, Krumm K, Neumann C, Sturm JA, Tscherne H. Pulmonary damage after intramedullary femoral nailing in sheep: is there an effect of different nailing methods? J Trauma. 1992;574–581. Pape HC, Dwenger A, Regel G, Schweitzer G, Jonas M, Remmers D, Krumm K, Neumann C, Sturm JA, Tscherne H. Pulmonary damage after intramedullary femoral nailing in sheep: is there an effect of different nailing methods? J Trauma. 1992;574–581.
49.
Zurück zum Zitat Pape HC, Grotz M, Remmers D, Dwenger A, Vaske R, Wisner D, Tscherne H. Multiple organ failure (MOF) after severe trauma—a sheep model. Intensive Care Med. 1998;24:590–598.PubMedCrossRef Pape HC, Grotz M, Remmers D, Dwenger A, Vaske R, Wisner D, Tscherne H. Multiple organ failure (MOF) after severe trauma—a sheep model. Intensive Care Med. 1998;24:590–598.PubMedCrossRef
50.
Zurück zum Zitat Pape HC, Grotz M, Schwermann T, Ruchholtz S, Lefering R, Rieger M, Tröger M, Graf von der Schulenburg JM, Krettek C; AG Polytrauma der DGU. [The development of a model to calculate the cost of care for the severely injured—an initiative of the Trauma Register of the DGU] [in German]. Unfallchirurg. 2003;106:348–357.PubMedCrossRef Pape HC, Grotz M, Schwermann T, Ruchholtz S, Lefering R, Rieger M, Tröger M, Graf von der Schulenburg JM, Krettek C; AG Polytrauma der DGU. [The development of a model to calculate the cost of care for the severely injured—an initiative of the Trauma Register of the DGU] [in German]. Unfallchirurg. 2003;106:348–357.PubMedCrossRef
51.
Zurück zum Zitat Pape HC, Lehmann U, van Griensven M, Gänsslen A, von Glinski S, Krettek C. Heterotopic ossifications in patients after severe blunt trauma with and without head trauma. J Orthop Trauma. 2001;15:229–237.PubMedCrossRef Pape HC, Lehmann U, van Griensven M, Gänsslen A, von Glinski S, Krettek C. Heterotopic ossifications in patients after severe blunt trauma with and without head trauma. J Orthop Trauma. 2001;15:229–237.PubMedCrossRef
52.
Zurück zum Zitat Pape HC, Oestern HJ, Leenen L, Yates DW, Stalp M, Grimme K, Tscherne H, Krettek C; German Polytrauma Study Group. Documentation of blunt trauma in Europe Survey of the current status of documentation and appraisal of the value of standardization. Eur J Trauma. 2000;5:233–247.CrossRef Pape HC, Oestern HJ, Leenen L, Yates DW, Stalp M, Grimme K, Tscherne H, Krettek C; German Polytrauma Study Group. Documentation of blunt trauma in Europe Survey of the current status of documentation and appraisal of the value of standardization. Eur J Trauma. 2000;5:233–247.CrossRef
53.
Zurück zum Zitat Pape HC, Regel G, Dwenger A, Krumm K, Schweitzer G, Krettek C, Sturm JA, Tscherne H. Influences of different methods of intramedullary femoral nailing on lung function in patients with multiple trauma. J Trauma. 1993;35:709–716.PubMedCrossRef Pape HC, Regel G, Dwenger A, Krumm K, Schweitzer G, Krettek C, Sturm JA, Tscherne H. Influences of different methods of intramedullary femoral nailing on lung function in patients with multiple trauma. J Trauma. 1993;35:709–716.PubMedCrossRef
54.
Zurück zum Zitat Pape HC, Regel G, Tscherne H. Local and systemic effects of fat embolization after intramedullary reaming and its influence by cofactors. Tech Orthop. 1996;11:2–13.CrossRef Pape HC, Regel G, Tscherne H. Local and systemic effects of fat embolization after intramedullary reaming and its influence by cofactors. Tech Orthop. 1996;11:2–13.CrossRef
55.
Zurück zum Zitat Pape HC, Remmers D, Grotz M, Kotzerke J, von Glinski S, van Griensven M, Dahlweid M, Sznidar S, Tscherne H. Reticuloendothelial system activity and organ failure in patients with multiple injuries. Arch Surg. 1999;134:421–427.PubMedCrossRef Pape HC, Remmers D, Grotz M, Kotzerke J, von Glinski S, van Griensven M, Dahlweid M, Sznidar S, Tscherne H. Reticuloendothelial system activity and organ failure in patients with multiple injuries. Arch Surg. 1999;134:421–427.PubMedCrossRef
56.
Zurück zum Zitat Pape HC, Remmers D, Grotz M, Schedel I, von Glinski S, Oberbeck R, Dahlweit M, Tscherne H. Levels of antibodies to endotoxin and cytokine release in patients with severe trauma: does posttraumatic dysergy contribute to organ failure? J Trauma. 1999;46:907–913.PubMedCrossRef Pape HC, Remmers D, Grotz M, Schedel I, von Glinski S, Oberbeck R, Dahlweit M, Tscherne H. Levels of antibodies to endotoxin and cytokine release in patients with severe trauma: does posttraumatic dysergy contribute to organ failure? J Trauma. 1999;46:907–913.PubMedCrossRef
57.
Zurück zum Zitat Pape HC, Remmers D, Kleemann W, Goris JA, Regel G, Tscherne H. Posttraumatic multiple organ failure—a report on clinical and autopsy findings. Shock. 1994;2:228–234.PubMedCrossRef Pape HC, Remmers D, Kleemann W, Goris JA, Regel G, Tscherne H. Posttraumatic multiple organ failure—a report on clinical and autopsy findings. Shock. 1994;2:228–234.PubMedCrossRef
58.
Zurück zum Zitat Pape HC, Remmers D, Rice J, Ebisch M, Krettek C, Tscherne H. Appraisal of early evaluation of blunt chest trauma: development of a standardized scoring system for initial clinical decision making. J Trauma. 2000;49:496–504.PubMedCrossRef Pape HC, Remmers D, Rice J, Ebisch M, Krettek C, Tscherne H. Appraisal of early evaluation of blunt chest trauma: development of a standardized scoring system for initial clinical decision making. J Trauma. 2000;49:496–504.PubMedCrossRef
59.
Zurück zum Zitat Pape HC, Schmidt RE, Rice J, van Griensven M, das Gupta R, Krettek C, Tscherne H. Biochemical changes after trauma and skeletal surgery of the lower extremity: quantification of the operative burden. Crit Care Med. 2000;28:3441–3448.PubMedCrossRef Pape HC, Schmidt RE, Rice J, van Griensven M, das Gupta R, Krettek C, Tscherne H. Biochemical changes after trauma and skeletal surgery of the lower extremity: quantification of the operative burden. Crit Care Med. 2000;28:3441–3448.PubMedCrossRef
60.
Zurück zum Zitat Pape HC, Tscherne H. Early definitive fracture fixation, pulmonary function and systemic effects. In: Baue AE, Faist E, Fry DE, eds. Multiple Organ Failure: Pathophysiology, Prevention, and Therapy. New York, NY: Springer Verlag; 2000:279–290.CrossRef Pape HC, Tscherne H. Early definitive fracture fixation, pulmonary function and systemic effects. In: Baue AE, Faist E, Fry DE, eds. Multiple Organ Failure: Pathophysiology, Prevention, and Therapy. New York, NY: Springer Verlag; 2000:279–290.CrossRef
61.
Zurück zum Zitat Pape HC, van Griensven M, Rice J, Gänsslen A, Hildebrand F, Zech S, Winny M, Lichtinghagen R, Krettek C. Major secondary surgery in blunt trauma patients and perioperative cytokine liberation: determination of the clinical relevance of biochemical markers. J Trauma. 2001;50:989–1000.PubMedCrossRef Pape HC, van Griensven M, Rice J, Gänsslen A, Hildebrand F, Zech S, Winny M, Lichtinghagen R, Krettek C. Major secondary surgery in blunt trauma patients and perioperative cytokine liberation: determination of the clinical relevance of biochemical markers. J Trauma. 2001;50:989–1000.PubMedCrossRef
62.
Zurück zum Zitat Patton GC, Coffey C, Sawyer SM, Viner RM, Haller DM, Bose K, Vos T, Ferguson J, Mathers CD. Global patterns of mortality in young people: a systematic analysis of population health data. Lancet. 2009;374:881–892.PubMedCrossRef Patton GC, Coffey C, Sawyer SM, Viner RM, Haller DM, Bose K, Vos T, Ferguson J, Mathers CD. Global patterns of mortality in young people: a systematic analysis of population health data. Lancet. 2009;374:881–892.PubMedCrossRef
63.
Zurück zum Zitat Peden M, McGee K, Krug E, eds. Injury: A Leading Cause of the Global Burden of Disease. Geneva, Switzerland: World Health Organization; 2002. Peden M, McGee K, Krug E, eds. Injury: A Leading Cause of the Global Burden of Disease. Geneva, Switzerland: World Health Organization; 2002.
64.
Zurück zum Zitat Probst C, Richter M, Haasper C, Lefering R, Otte D, Oestern HJ, Krettek C, Hüfner T; Traumaregister der Deutschen Gesellschaft für Unfallchirurgie. [Trauma and accident documentation in Germany compared with elsewhere in Europe] [in German]. Chirurg. 2008;79:650–656.PubMedCrossRef Probst C, Richter M, Haasper C, Lefering R, Otte D, Oestern HJ, Krettek C, Hüfner T; Traumaregister der Deutschen Gesellschaft für Unfallchirurgie. [Trauma and accident documentation in Germany compared with elsewhere in Europe] [in German]. Chirurg. 2008;79:650–656.PubMedCrossRef
65.
Zurück zum Zitat Regel G, Lobenhoffer P, Grotz M, Pape HC, Lehmann U, Tscherne H. Treatment results of patients with multiple trauma: an analysis of 3406 cases treated between 1972 and 1991 at a German Level I Trauma Center. J Trauma. 1995;38:70–78.PubMedCrossRef Regel G, Lobenhoffer P, Grotz M, Pape HC, Lehmann U, Tscherne H. Treatment results of patients with multiple trauma: an analysis of 3406 cases treated between 1972 and 1991 at a German Level I Trauma Center. J Trauma. 1995;38:70–78.PubMedCrossRef
66.
Zurück zum Zitat Regel G, Seekamp A, Takacs J, Bauch S, Sturm JA, Tscherne H. [Rehabilitation and reintegration of polytraumatized patients] [in German]. Unfallchirurg. 1993;96:341–349.PubMed Regel G, Seekamp A, Takacs J, Bauch S, Sturm JA, Tscherne H. [Rehabilitation and reintegration of polytraumatized patients] [in German]. Unfallchirurg. 1993;96:341–349.PubMed
67.
Zurück zum Zitat Remmers D, Dwenger A, Grotz M, Seekamp A, Pape HC, Gruner A, Hafemann R, Regel G. Attenuation of multiple organ dysfunction in a chronic sheep model by the 21-aminosteroid U74389G. J Surg Res. 1996;62:278–283.PubMedCrossRef Remmers D, Dwenger A, Grotz M, Seekamp A, Pape HC, Gruner A, Hafemann R, Regel G. Attenuation of multiple organ dysfunction in a chronic sheep model by the 21-aminosteroid U74389G. J Surg Res. 1996;62:278–283.PubMedCrossRef
68.
Zurück zum Zitat Remmers DE, Cioffi WG, Bland KI, Wang P, Angele MK, Chaudry IH. Testosterone: the crucial hormone responsible for depressing myocardial function in males after trauma-hemorrhage. Ann Surg. 1998;227:790–799.PubMedCrossRef Remmers DE, Cioffi WG, Bland KI, Wang P, Angele MK, Chaudry IH. Testosterone: the crucial hormone responsible for depressing myocardial function in males after trauma-hemorrhage. Ann Surg. 1998;227:790–799.PubMedCrossRef
69.
Zurück zum Zitat Remmers DE, Wang P, Cioffi WG, Bland KI, Chaudry IH. Chronic resuscitation after trauma-hemorrhage and acute fluid replacement improves hepatocellular function and cardiac output. Ann Surg. 1998;227:112–119.PubMedCrossRef Remmers DE, Wang P, Cioffi WG, Bland KI, Chaudry IH. Chronic resuscitation after trauma-hemorrhage and acute fluid replacement improves hepatocellular function and cardiac output. Ann Surg. 1998;227:112–119.PubMedCrossRef
70.
Zurück zum Zitat Rhodes A. Gender differences in the use of outpatient mental health services. J Ment Health Adm. 1994;21:338–346.PubMedCrossRef Rhodes A. Gender differences in the use of outpatient mental health services. J Ment Health Adm. 1994;21:338–346.PubMedCrossRef
71.
Zurück zum Zitat Rice DP, MacKenzie EJ. Cost of Injury in the United States: A Report to Congress. Washington, DC: National Academies Press; 1989. Rice DP, MacKenzie EJ. Cost of Injury in the United States: A Report to Congress. Washington, DC: National Academies Press; 1989.
72.
Zurück zum Zitat Richter M, Krettek C, Otte D, Wiese B, Stalp M, Ernst S, Pape HC. Correlation between crash severity, injury severity and clinical course in car occupants with thoracic trauma: a technical and medical study. J Trauma. 2001;51:10–16.PubMedCrossRef Richter M, Krettek C, Otte D, Wiese B, Stalp M, Ernst S, Pape HC. Correlation between crash severity, injury severity and clinical course in car occupants with thoracic trauma: a technical and medical study. J Trauma. 2001;51:10–16.PubMedCrossRef
73.
Zurück zum Zitat Richter M, Thermann H, Wippermann B, Otte D, Schratt HE, Tscherne H. Foot fractures in restrained front seat car occupants: a long-term study over twenty-three years. J Orthop Trauma. 2001;15:287–293.PubMedCrossRef Richter M, Thermann H, Wippermann B, Otte D, Schratt HE, Tscherne H. Foot fractures in restrained front seat car occupants: a long-term study over twenty-three years. J Orthop Trauma. 2001;15:287–293.PubMedCrossRef
74.
Zurück zum Zitat Roberts R, Frutos P, Giavarella G. Distribution of variable vs fixed costs of hospital care. JAMA. 1999;281:644–649.PubMedCrossRef Roberts R, Frutos P, Giavarella G. Distribution of variable vs fixed costs of hospital care. JAMA. 1999;281:644–649.PubMedCrossRef
75.
Zurück zum Zitat Rossi R. [Early care or quick transport? The effectiveness of preclinical treatment of emergency patients] [in German]. Anaesthesist. 1997;46:126–132.PubMedCrossRef Rossi R. [Early care or quick transport? The effectiveness of preclinical treatment of emergency patients] [in German]. Anaesthesist. 1997;46:126–132.PubMedCrossRef
76.
Zurück zum Zitat Ruchholtz S, Nast-Kolb D, Waydhas C, Lefering R; AG Polytrauma der DGU. [An interhospital comparison of the treatment of trauma patients—analysis from the German Trauma Registry] [in German]. Hefte zu Der Unfallchirurg. 1997;268:262–265.CrossRef Ruchholtz S, Nast-Kolb D, Waydhas C, Lefering R; AG Polytrauma der DGU. [An interhospital comparison of the treatment of trauma patients—analysis from the German Trauma Registry] [in German]. Hefte zu Der Unfallchirurg. 1997;268:262–265.CrossRef
77.
Zurück zum Zitat Sarkar B, Brunsvold ME, Cherry-Bukoweic JR, Hemmila MR, Park PK, Raghavendran K, Wahl WL, Wang SC, Napolitano LM. American College of Surgeons’ Committee in Trauma Performance Improvement and Patient Safety program: maximal impact in a mature trauma center. J Trauma. 2011;71:1447–1453; discussion 1453–1454. Sarkar B, Brunsvold ME, Cherry-Bukoweic JR, Hemmila MR, Park PK, Raghavendran K, Wahl WL, Wang SC, Napolitano LM. American College of Surgeons’ Committee in Trauma Performance Improvement and Patient Safety program: maximal impact in a mature trauma center. J Trauma. 2011;71:1447–1453; discussion 1453–1454.
78.
Zurück zum Zitat Seekamp A, Regel G, Tscherne H. Rehabilitation and reintegration of multiply injured patients: an outcome study with special reference to multiple lower limb fractures. Injury. 1996;27:133–138.PubMedCrossRef Seekamp A, Regel G, Tscherne H. Rehabilitation and reintegration of multiply injured patients: an outcome study with special reference to multiple lower limb fractures. Injury. 1996;27:133–138.PubMedCrossRef
79.
Zurück zum Zitat Shenassa ED, Rogers ML, Spalding KL, Roberts MB. Safer storage of firearms at home and risk of suicide: a study of protective factors in a nationally representative sample. J Epidemiol Community Health. 2004;58:841–848.PubMedCrossRef Shenassa ED, Rogers ML, Spalding KL, Roberts MB. Safer storage of firearms at home and risk of suicide: a study of protective factors in a nationally representative sample. J Epidemiol Community Health. 2004;58:841–848.PubMedCrossRef
80.
Zurück zum Zitat Stalp M, Koch C, Regel G, Krettek C, Pape HC. [Development of a scoring system for the standardized evaluation of the quality of rehabilitation in polytraumatized patients (HASPOC)] [in German]. Chirurg. 2001;72:312–318.PubMedCrossRef Stalp M, Koch C, Regel G, Krettek C, Pape HC. [Development of a scoring system for the standardized evaluation of the quality of rehabilitation in polytraumatized patients (HASPOC)] [in German]. Chirurg. 2001;72:312–318.PubMedCrossRef
83.
Zurück zum Zitat Sturm JA, Lewis FR Jr, Trentz O, Oestern HJ, Hempelman G, Tscherne H. Cardiopulmonary parameters and prognosis after severe multiple trauma. J Trauma. 1979;19:305–318.PubMedCrossRef Sturm JA, Lewis FR Jr, Trentz O, Oestern HJ, Hempelman G, Tscherne H. Cardiopulmonary parameters and prognosis after severe multiple trauma. J Trauma. 1979;19:305–318.PubMedCrossRef
84.
Zurück zum Zitat Tscherne H. [Traffic accidents] [in German]. Wien Med Wochenschr. 1966;116:105–108.PubMed Tscherne H. [Traffic accidents] [in German]. Wien Med Wochenschr. 1966;116:105–108.PubMed
85.
Zurück zum Zitat Tscherne H, Oestern HJ, Sturm J. Osteosynthesis of major fractures in polytrauma. World J Surg. 1983;7:80–87.PubMedCrossRef Tscherne H, Oestern HJ, Sturm J. Osteosynthesis of major fractures in polytrauma. World J Surg. 1983;7:80–87.PubMedCrossRef
86.
Zurück zum Zitat Tscherne H, Regel G, Pape HC, Pohlemann T, Krettek C. Internal fixation of multiple fractures in patients with polytrauma. Clin Orthop Relat Res. 1998;347:62–78.PubMedCrossRef Tscherne H, Regel G, Pape HC, Pohlemann T, Krettek C. Internal fixation of multiple fractures in patients with polytrauma. Clin Orthop Relat Res. 1998;347:62–78.PubMedCrossRef
88.
Zurück zum Zitat Udsching P. Sozialgesetzbuch (SGB XI). Munich, Germany: Beck Juristischer Verlag; 2000. Udsching P. Sozialgesetzbuch (SGB XI). Munich, Germany: Beck Juristischer Verlag; 2000.
89.
Zurück zum Zitat Wisner DH, Sturm JA. Controversies in the fluid management of post-traumatic lung disease. Injury. 1986;17:295–300.PubMedCrossRef Wisner DH, Sturm JA. Controversies in the fluid management of post-traumatic lung disease. Injury. 1986;17:295–300.PubMedCrossRef
90.
Zurück zum Zitat Wörz M, Busse R. Analysing the impact of health-care system change in the EU member states—Germany. Health Econ. 2005;14(suppl 1):S133–S149.PubMedCrossRef Wörz M, Busse R. Analysing the impact of health-care system change in the EU member states—Germany. Health Econ. 2005;14(suppl 1):S133–S149.PubMedCrossRef
91.
Zurück zum Zitat Yücel N, Lefering R, Maegele M, Vorweg M, Tjardes T, Ruchholtz S, Neugebauer EA, Wappler F, Bouillon B, Rixen D; Polytrauma Study Group of the German Trauma Society. Trauma Associated Severe Hemorrhage (TASH)-Score: probability of mass transfusion as surrogate for life threatening hemorrhage after multiple trauma. J Trauma. 2006;60:1228–1236; discussion 1236–1237. Yücel N, Lefering R, Maegele M, Vorweg M, Tjardes T, Ruchholtz S, Neugebauer EA, Wappler F, Bouillon B, Rixen D; Polytrauma Study Group of the German Trauma Society. Trauma Associated Severe Hemorrhage (TASH)-Score: probability of mass transfusion as surrogate for life threatening hemorrhage after multiple trauma. J Trauma. 2006;60:1228–1236; discussion 1236–1237.
92.
Zurück zum Zitat Zelle BA, Brown SR, Panzica M. The impact of injuries below the knee joint on the long-term functional outcome following polytrauma. Injury. 2005;36:169–177.PubMedCrossRef Zelle BA, Brown SR, Panzica M. The impact of injuries below the knee joint on the long-term functional outcome following polytrauma. Injury. 2005;36:169–177.PubMedCrossRef
Metadaten
Titel
Trauma Care in Germany: An Inclusive System
verfasst von
Johannes A. Sturm, MD
Hans-Christoph Pape, MD
Thomas Dienstknecht, MD
Publikationsdatum
01.09.2013
Verlag
Springer US
Erschienen in
Clinical Orthopaedics and Related Research® / Ausgabe 9/2013
Print ISSN: 0009-921X
Elektronische ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-013-2967-x

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